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Abstract: PO0422

The DAPA-CKD-Like Population in a Contemporary US Healthcare System: Cohort Characteristics and Clinical Outcomes

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Olufade, Tope, AstraZeneca, Wilmington, North Carolina, United States
  • Lamerato, Lois, Henry Ford Health System, Detroit, Michigan, United States
  • Garcia Sanchez, Juan Jose, AstraZeneca UK Ltd, Cambridge, Cambridgeshire, United Kingdom
  • Jiang, Like, AstraZeneca, Wilmington, North Carolina, United States
  • Huang, Joanna C., AstraZeneca, Wilmington, North Carolina, United States
  • Nolan, Stephen, AstraZeneca UK Ltd, Cambridge, Cambridgeshire, United Kingdom
Background

The DAPA-CKD Trial is the first SGLT-2i renal outcome trial to test the efficacy and safety of an SGLT-2i, dapagliflozin, in patients with diagnosed CKD with and without T2D.
To appropriately evaluate future results and aid clinical interpretation of the DAPA-CKD trial, the present study assessed the renal and CV outcomes of a “DAPA-CKD-like population” (eGFR 25-75ml/min/1.73m2 and UACR 200-5000mg/g) in a contemporary US healthcare system.

Methods

Administrative data from the Henry Ford Health System was used to identify patients with CKD stages 2 through 4 between 2006 and 2016 based on eGFR lab reading (n=38,376). Exclusions included no confirmatory eGFR > 90 days from index date, death within 30 days, history of renal transplant, and evidence of renal replacement therapy, or progression to CKD stage 5 during the baseline period (6 months pre or post index date). Within that cohort, 17,742 had eGFR (25-75ml/min/1.73m2) and 9,177 had a UACR (0-5000 mg/g) within 12 months of index date. Additional exclusions were type 1 diabetes, lupus nephritis and polycystic kidney disease. Patients were followed through December 31st, 2018.

Results

Of the 6,557 patients that met the eligibility criteria and were included in the study cohort, the mean age was 62.9 years and 46.2% were male. The population was stratified by UACR (0-<30, 30–199, 200–5,000mg/g). Across all outcomes assessed, incidences were highest in the DAPA-CKD-like cohort (UACR 200-5000mg/g) (HF 36.1%; MI 11.3%, Stroke 8.9%; ESKD 18.6%; Mortality 18.5%; see Table 1). The greatest increase was observed for renal outcomes particularly ESKD, increasing from 0.9% (UACR 0-<30mg/g) to 3.4% (UACR 30-199mg/g) to 18.6% (UACR 200-5000mg/g).

Conclusion

In a contemporary US healthcare system, there remains significant adverse renal, CV and mortality outcomes among patients fitting the DAPA-CKD study inclusion criteria. These results highlight the unmet need existing for additional therapies to delay disease progression and improve outcomes and survival in this high risk population.

Funding

  • Commercial Support